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Thyroid-Stimulating Hormone at Grassroots Health - July 2020

Thyroid-stimulating hormone (TSH) is a hormone produced by the pituitary gland that stimulates the production of hormones from the thyroid that are essential to many bodily functions such as metabolism, brain development, bone health, muscle control, heart rate, and body temperature.

Thyroid dysfunction is under-diagnosed with some population studies indicating that up to 10% of Americans may have thyroid dysfunction. A TSH test can indicate whether your thyroid gland is working normally, or if it’s overactive (hyperthyroidism) or underactive (hypothyroidism). An overactive thyroid gland can produce symptoms such as irritability, diarrhea, heart palpitations, heat sensitivity, and insomnia while an underactive thyroid gland can produce fatigue, unexplained weight gain, infertility, and mood swings. A TSH test can detect thyroid dysfunction before you have any symptoms.

The normal TSH range depends on a person’s age and pregnancy status, with levels tending to be higher as a person gets older and lower during pregnancy. According to the American Thyroid Association, doctors generally consider levels between 0.4 and 4.0 µU/mL to be within the normal range with levels between 0.0 and 0.4 µU/mL indicating hyperthyroidism, levels between 4.0 and 10.0 µU/mL indicating mild hypothyroidism, and levels 10 µU/mL or higher indicating hypothyroidism. However, some experts consider normal levels to be between 0.5 and 2.0-2.5 µU/mL.

Additional tests may be recommended if TSH levels are out of range to give a more definitive diagnosis of thyroid disease or dysfunction. The treatment and diagnosis must be undertaken with a medical doctor or other primary health care provider.
What are the TSH levels among GrassrootsHealth Participants?

GrassrootsHealth offers a TSH dried blood spot test. Among the 229 participants who have tested their TSH levels, the average level was 1.5 µU/mL. As you can see from the chart below, 86% of these participants have levels in the normal range, 5% have levels in the range indicating possible hyperthyroidism, 7% have levels in the range indicating possible mild hypothyroidism, and 2% have levels indicating possible hypothyroidism.

Calcium, Parathyroid Hormone, and Vitamin D in Patients with Primary Hyperparathyroidism: Normograms Developed from 10,000 Cases.

Endocr Pract. 2010 Dec 6:1-26.
Norman J, Goodman A, Politz D.
Norman Parathyroid Center, Tampa, Florida.

Objective: To define more clearly the typical and atypical biochemical profiles of patients with surgically proven primary hyperparathyroidism.

Methods: A single-center, prospectively conducted study of serum calcium, parathyroid hormone, and Vitamin D in 10,000 consecutive patients over a 7 year period with surgically proven PHPT. Over 210,000 calcium, PTH, and vitamin D values were evaluated.

Results: Both calcium and PTH levels demonstrate a Gaussian distribution with the average calcium being 10.9±0.6 mg/dl and the average PTH being 105.8±48 pg/ml. The average highest calcium and PTH was 11.4±0.7 mg/dl and 115.3±50 pg/ml, respectively. At least one calcium level of 11.0 mg/dl is seen in 87% of patients, but only 21% had one or more calcium levels above 11.5 mg/dl. Only 7% had a single serum calcium level reaching 12.0 mg/dl. Normocalcemic HPT was seen in 2.5% of patients who had identical findings at surgery. An average PTH less than 65 pg/ml was seen in 16.5% with 10.5% having zero high PTH values. The average vitamin D-25 was 22.4±9 ng/ml, with levels decreasing as calcium levels increased (p<0.001); 36% had vitamin D-25 levels below 20ng/ml.

Conclusion: Patients with PHPT present with a number of distinct biochemical profiles, but as a group present with a near-normal Gaussian distribution of both calcium and PTH. Either serum calcium or PTH remained normal in 13% of patients yet the findings at surgery are similar to those with elevated calcium or PTH. Low vitamin D is an expected finding in patients with PHPT, decreasing as serum calcium levels increased. PMID: 21134884

Example normogram
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High vitamin D is associated with low TSH = Thyroid-stimulating hormone = Thyrotropin

High Vitamin D Status in Younger Individuals is Associated with Low Circulating Thyrotropin
Thyroid. 2012 Aug 30.
Chailurkit LO, Aekplakorn W, Ongphiphadhanakul B.

Ramathibodi Hospital, Medicine, Bangkok, Thailand; ralcl at mahidol.ac.th.

Background: Vitamin D is an immunomodulator and may affect autoimmune thyroid diseases. Vitamin D has also been shown to influence thyrocytes directly by attenuating the thyrotropin (TSH) stimulated iodide uptake and cell growth. However, it is unclear how vitamin D status is related to TSH at the population level. The goal of the present study was to investigate the relationship between vitamin D status and TSH levels according to thyroid autoantibodies in a population-based health survey in Thailand.

Methods: A total of 2,582 adults, aged 15-98 years, were randomly selected according to geographical region from the Thailand 4th National Health Examination Survey sample. Serum levels of 25-hydroxyvitamin D (25(OH)D), TSH, thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) were measured in all subjects.

Results: The mean age was 55.0 ± 0.4 (SE) years. Fifty percent of the subjects were males. In subjects positive for serum TgAb, serum TSH levels were higher whereas total serum 25(OH)D levels were lower. In addition, the prevalence of vitamin D insufficiency in TgAb-positive subjects was significantly higher than that observed in TPOAb and TgAb-negative subjects, whether based on cutoff values of 20 or 30 ng/mL: 8.3% vs 5.6%, p < 0.05; or 47.6% vs 42.0%, p < 0.05, respectively. However, vitamin D status was not associated with positive TPOAb and/or TgAb after controlling for gender and age. To explore the probable interaction between vitamin D status and age on serum TSH, analyses were performed according to age tertiles, it was found that higher 25(OH)D levels were independently associated with lower TSH, but only in subjects in the lowest age tertile.

Conclusions: This population-based study showed that high vitamin D status in younger individuals is associated with low circulating thyrotropin.

PMID: 22931506
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TSH wikipedia

has the following graphic

Search PubMed: for ((thyroid[Title]) OR hyperthyroid[Title]) AND vitamin d[Title]
148 items as of Oct 2019

Fix Thyroid then increase vitamin D - Oct 2013

Fix Thyroid then increase vitamin D - Oct 2013
Includes PDF. PPT, and audio of the presentation
Brief summary

  1. If you have any Thyroid problems, do not take Vitamin D until you have corrected other problems like Adrenal Deficiency
  2. Start with 1,000 IU vitamin D daily for the first week
  3. Increase by 1,000 IU each week for 3+ weeks
  4. Should also increase Iodine

Thyroid Supplements With a Kick New York Times, Jan 2014

Nothing about vitamin D, but interesting

  • Commenting on Thyroid Nov 2013
  • Researchers who tested 10 popular thyroid-boosting products sold online found that nine contained the hormones
    thyroxine (T4) or triiodothyronine (T3), sometimes both.
    one supplement delivered 91 micrograms of T4 and 16.5 micrograms of T3 (more than in some prescription drugs)

While looking at the above journal article I did a query for Vitamin D and found the following - Jan 2014

Low Levels of Serum Vitamin D3 are Associated with Autoimmune Thyroid Disease in Pre-Menopausal Women Thyroid Journal, Dec 2013

Background: Low serum vitamin D level has been associated with several autoimmune diseases, but its association with thyroid autoimmunity is unclear.
We evaluated the association of serum vitamin D level with the prevalence of autoimmune thyroid disease (AITD).

Methods: Our cross-sectional study included subjects who underwent routine health check-ups, which included assays of serum 25-hydroxy vitamin D3 (25(OH)D3) and anti-thyroid peroxidase antibody (TPO-Ab), as well as thyroid ultrasonography (US) between 2008 and 2012 at Asan Medical Center. We defined AITD according to the level of TPO-Ab and US findings.

Results: Total 6,685 subjects (Male, 58%; Female, 42%) were enrolled for this study. Overall prevalence of TPO-Ab positivity and both TPO-Ab/US positivity were 10.1% (Male, 6.3%; Female, 15.3%) and 5.4% (Male, 2.3%; Female, 9.7%), respectively. In female subjects, mean serum 25(OH)D3 levels were significantly lower in TPO-Ab(+) (22.0 vs. 23.5 ng/mL, P=0.030), and TPO-Ab(+)/US(+) group (21.6 vs. 23.4 ng/mL, P=0.027) as compared with corresponding control group, respectively. According to the level of serum 25(OH)D3, the prevalence of TPO-Ab positivity (21.2%, 15.5% and 12.6% in deficient, insufficient, and sufficient group, respectively, P=0.001) and both TPO-Ab/US positivity (14.7%, 9.9% and 7.1% in deficient, insufficient, and sufficient group, respectively, P<0.001) was decreased in female subjects. Interestingly, this pattern was significant only in pre-menopausal women (P=0.003 and P<0.001, respectively), but not in post-menopausal women. Multivariate analysis indicated that the adjusted odds ratios (OR) for AITD among those in the 25(OH)D3-deficient (TPO-Ab(+); OR=1.95, P=0.001 and TPO-Ab(+)/US(+); OR=2.36, P<0.001), and -insufficient group (TPO-Ab(+); OR=1.31, P=0.043 and TPO-Ab(+)/US(+); OR=1.50, P=0.017) were significantly increased when compared with -sufficient group.

Conclusions: The level of serum vitamin D was significantly lower in pre-menopausal women with AITD.
Vitamin D deficiency and insufficiency were significantly associated with AITD in pre-menopausal women.

Note - that is not much of a difference in Vitamin D levels.

2800 IU vitamin D helped when given both before and after parathyroidectomy - March 2014

Vitamin D treatment in primary hyperparathyroidism: a randomized placebo controlled trial.
J Clin Endocrinol Metab. 2014 Mar;99(3):1072-80. doi: 10.1210/jc.2013-3978. Epub 2014 Jan 13.
Rolighed L1, Rejnmark L, Sikjaer T, Heickendorff L, Vestergaard P, Mosekilde L, Christiansen P.

Low 25-hydroxyvitamin D levels are common in patients with primary hyperparathyroidism (PHPT) and associated with higher PTH levels and hungry bone syndrome after parathyroidectomy (PTX). However, concerns have been raised about the safety of vitamin D supplementation in PHPT.
We aimed to assess safety and effects on calcium homeostasis and bone metabolism of supplementation with high doses of vitamin D in PHPT patients.
This was an investigator-initiated double-blind, randomized, placebo-controlled, parallel-group trial from a single center.
Forty-six PHPT patients were recruited, with a mean age of 58 (range 29-77) years, and 35 (76%) were women.
Intervention included daily supplementation with 70 μg (2800 IU) cholecalciferol or identical placebo for 52 weeks. Treatment was administered 26 weeks before PTX and continued for 26 weeks after PTX.
PTH, calcium homeostasis, and bone metabolism were evaluated.
Preoperatively, 25-hydroxyvitamin D increased from 50 to 94 nmol/L in the treatment group and decreased from 57 to 52 nmol/L in the placebo group (P < .001). Compared with placebo, vitamin D decreased PTH significantly by 17% before PTX (P = .01), increased lumbar spine bone mineral density by 2.5% (P = .01), and decreased C-terminal β-CrossLaps by 22% (P < .005). The trabecular bone score did not change in response to treatment, but improved after PTX. Postoperatively, PTH remained lower in the cholecalciferol group compared with the placebo group (P = .04). Plasma creatinine and plasma and urinary calcium did not differ between groups.
Daily supplementation with a high vitamin D dose safely improves vitamin D status and decreases PTH in PHPT patients. The vitamin D treatment is accompanied by reduced bone resorption and improved bone mineral density before operation.

Attached files

ID Name Comment Uploaded Size Downloads
14060 TSH GRH July 2020.jpg admin 21 Jul, 2020 10:25 53.32 Kb 174
6243 Vitamin D in Thyroid Disorders - 2015.pdf PDF 2015 admin 13 Dec, 2015 15:17 319.42 Kb 1219
3173 Rufus Greenbaum 10% faster.mp3 admin 27 Oct, 2013 19:55 5.45 Mb 2908
1583 Thyroid_system.png admin 31 Aug, 2012 13:53 41.21 Kb 8298
414 PTH normoogram.gif admin 18 Jan, 2011 23:01 28.83 Kb 13699
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